Dermatology

Question 1

What are the symptoms of cellulitis?

Answer 1

Acute onset of red, painful, swollen skin - usually unilateral
Peau d’orange
Blistering and bleeding
Fever and malaise
Lymphadenopathy

Question 2

What are the risk factors for cellulitis?

Answer 2

Diabetes
Venous insufficiency
Eczema
Oedema and lymphoedema
Obesity

Question 3

How is cellulitis investigated?

Answer 3

Usually clinical diagnosis
FBC (WCC may be elevated or low in patients with sepsis/immunocompromising factors)
ESR and CRP
Blood culture and sensitivities (if patient needs admission)

Question 4

How is cellulitis classified?

Answer 4

Eron Classification
Class I: no signs of systemic toxicity, no uncontrolled co-morbidities
Class II: systemically unwell or systemically well with co-morbidity (PAD, obesity, venous insufficiency)
Class III: significant systemic upset
Class IV: sepsis syndrome or life-threatening infection

Question 5

How is cellulitis treated?

Answer 5

Class i: oral flucloxacillin (clarithromycin if allergic, erythromycin if pregnant)
Class II: oral flucloxacillin or IV co-amoxiclav
Class III and IV: IV co-amoxiclav

Question 6

What organisms classically cause cellulitis?

Answer 6

Streptococcus pyogenes
Staphylococcus aureus
Streptococcus dysgalactiae
Can also be caused by MRSA

Question 7

What are the risk factors for eczema?

Answer 7

Allergic rhinitis
Asthma
Age <5 years
Family history

Question 8

What are the symptoms of eczema?

Answer 8

Pruritis
Xerosis (dry skin)
Erythema, scaling
Lichenification
Hypopigmentation

Question 9

How is eczema treated?

Answer 9

Emollients
Topical corticosterids (hydrocortisone, eumovate, betnovate, dermovate)
Oral/IV flucloxacillin for S. aureus infections

Question 10

What is psoriasis?

Answer 10

Chronic inflammatory skin condition caused by hyperproliferation of keratinocytes

Question 11

What are the types of psoriasis?

Answer 11

Plaque psoriasis: most common
Guttate psoriasis: 2nd most common, occurs commonly in children
Flexural psoriasis
Pustular psoriasis
Erythrodermic psoriasis

Question 12

What are the features of plaque psoriasis?

Answer 12

Seen commonly on extensor surfaces
Auspitz sign: small pinpoint bleeding when plaques peeled off
Koebner phenomenon: physical stimuli or skin injury leads to skin lesions

Question 13

What are the features of guttate psoriasis?

Answer 13

Affects trunk and limbs
More common in children
Raindrop plaques
Often triggered by streptococcal throat infection

Question 14

What are the features of flexural psoriasis?

Answer 14

Affects body folds (e.g. axilla, groin, peri-anal area)
Less scaly, more smooth

Question 15

How is psoriasis managed?

Answer 15

1st line: topical hydrocortisone and vitamin D (calcipotriol) OD
Phototherapy (secondary care)
Oral methotrexate

Question 16

What are the risk factors for basal cell carcinoma?

Answer 16

Most common skin cancer
UV-light or skin exposed
FHx
Lighter skin

Question 17

What are the features of basal cell carcinoma?

Answer 17

initially a pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central ‘crater’
doesn’t typically metastasise

Question 18

What are the features of squamous cell carcinoma?

Answer 18

rapidly expanding painless, ulcerate nodules
may have a cauliflower-like appearance
there may be areas of bleeding